“Prescription Drugs and the U.S. Military — The War…on Drugs“, Melody Petersen, Men’s Health magazine, current issue (undated) — “Our Military is fielding one of the most heavily medicated fighting forces in the history of war. Our soldiers aren’t just fighting our enemies, they’re often also fighting their prescriptions.

Richard Maltz (Major, US Army, retired) writes about the proposition that the “Cognitive Domain” is the dominant domain in conflict generally, and in warfare in particular. He has 28 years commissioned service in Military Intelligence, Counter- Terrorism, and other fields. His latest work is:

“The Epistemology of Strategy“, To be presented to the XX Annual Strategy Conference at the U.S. Army War College, 19 April 2009 (26 pages) — Hat tip to DNI!

His articles published in SETREP (journal of the Royal Canadian Military Institute):

It is too easy to confuse piracy with water-borne terrorist acts. Don’t believe the hype and consider the source.

Modern pirates bear little resemblance to popular romantic Hollywood characters. Increasingly violent and greedy, their actions seem an affront to the very ideals of Western civilization. Armchair admirals and politicians are quick to shake their fists, avowing, “Something must be done.” Maritime industry is quick to follow, with unsettling incident accounts and dire financial projections. Yet, more informed analysis of piracy reveals that the impact in blood and treasure is altogether minimal.

Indeed, common misperceptions abound. While maritime piracy incidents capture media attention and generate international calls for action, the piracy threat is in fact overstated. It is nothing more than high-seas criminal activity, better addressed by law enforcement agencies than warships. As a localized nuisance, it should not serve to shape maritime force structure or strategy.

The distinction between piracy and terrorism is neither semantic nor academic. If piracy, the responsibility lies with local law enforcement officials, not the military. But maritime terrorism means scrambling the Navy.

The omens for wind power are very good, and there is cause to believe that the EU’s 2020 targets in this area will be exceeded. But as capacity grows, it may be wind’s impact on electricity prices that presents the most immediate problem. Wind’s intermittency cannot be wished away, even if it can be ameliorated, and the development of the infrastructure needed to deal with it is lagging the installation of wind power itself.

The fact of the matter is, swine flu has been hopping from pigs to humans for decades, sometimes causing disease, sometimes not. According to a study done by the Centers for Disease Control, 76% of swine exhibitors at a 1988 county fair had antibodies in their bloodstream indicating a prior swine flu infection, even though the exhibitors showed no signs of illness. There was also an outbreak of swine flu among military recruits in Fort Dix, New Jersey in 1976, causing severe illness in 13 soldiers and one death. With this current swine flu outbreak, we simply don’t know what to expect. There’s been no reliable pattern. Some people have gotten mildly ill, and some have died. Some have probably been transiently infected and didn’t even notice.

But I don’t think we need to worry about this pandemic too much, because there’s one thing to keep in mind when news of a unique flu strain breaks: perspective. As of this writing, 80 people in Mexico have succumbed to swine flu. By comparison, the CDC estimates that 36,000 people in the United States die each year of influenza-related illnesses. And in spite of this, we in the medical community still have a hard time convincing people to get their flu shots. If you’re not afraid of influenza, then you shouldn’t be afraid of the swine flu. Even in the event that someone gets infected with swine flu, we have medications with demonstrated effectiveness against the strain that’s currently active.

About the author: Dr. McNamee is Associate Professor of Internal Medicine and Program Director of the Internal Medicine Residency Program at the Sanford School of Medicine of the University of South Dakota.

(4) “Obama’s Sins of Omission“, Andrew J. Bacevich, Counterpunch, 27 April 2009 — What is the purpose of the US military?– Excerpt:

But however much Obama may differ from Bush on particulars, he appears intent on sustaining the essentials on which the Bush policies were grounded. Put simply, Obama’s pragmatism poses no threat to the reigning national security consensus. Consistent with the tradition of American liberalism, he appears intent on salvaging that consensus.

For decades now, that consensus has centered on what we might call the Sacred Trinity of global power projection, global military presence, and global activism – the concrete expression of what politicians commonly refer to as “American global leadership.” The United States configures its armed forces not for defense but for overseas “contingencies.” To facilitate the deployment of these forces it maintains a vast network of foreign bases, complemented by various access and overflight agreements. Capabilities and bases mesh with and foster a penchant for meddling in the affairs of others, sometimes revealed to the public, but often concealed.

… What the president is doing and saying matters less than what he has not done. The sins of omission are telling: There is no indication that Obama will pose basic questions about the purpose of the US military; on the contrary, he has implicitly endorsed the proposition that keeping America safe is best accomplished by maintaining in instant readiness forces geared up to punish distant adversaries or invade distant countries. Nor is there any indication that Obama intends to shrink the military’s global footprint or curb the appetite for intervention that has become a signature of US policy.

Despite lip service to the wonders of soft power, Pentagon spending, which exploded during the Bush era, continues to increase.

… Obama’s revised approach to the so-called Long War, formerly known as the Global War on Terror, should hearten neoconservative and neoliberal exponents of American globalism: Now in its eighth year, this war continues with no end in sight. Those who actually expected Obama to “change the way Washington works” just might feel disappointed. Far than abrogating the Sacred Trinity, the president appears intent on investing it with new life.

About the author: Andrew J. Bacevich (Colonel, US Army, retired) is Professor of International Relations and History at Boston University. A graduate of the U. S. Military Academy, he received his Ph. D. in American Diplomatic History from Princeton University. Before joining the faculty of Boston University in 1998, he taught at West Point and at Johns Hopkins University.

(5) “Prescription Drugs and the U.S. Military — The War…on Drugs“, Melody Petersen, Men’s Health magazine, current issue (undated) — “Our Military is fielding one of the most heavily medicated fighting forces in the history of war. Our soldiers aren’t just fighting our enemies, they’re often also fighting their prescriptions. Excerpt:

… In deploying an all-volunteer army to fight two ongoing wars, in Iraq and Afghanistan, the Pentagon has increasingly relied on prescription drugs to keep its warriors on the front lines. In recent years, the number of military prescriptions for antidepressants, sleeping pills, and painkillers has risen as soldiers come home with battered bodies and troubled minds. And many of those service members are then sent back to war theaters in distant lands with bottles of medication to fortify them.

According to data from a U. S. Army mental-health survey released last year, about 12 percent of soldiers in Iraq and 15 percent of those in Afghanistan reported taking antidepressants, antianxiety medications, or sleeping pills. Prescriptions for painkillers have also skyrocketed. Data from the Department of Defense last fall showed that as of September 2007, prescriptions for narcotics for active-duty troops had risen to almost 50,000 a month, compared with about 33,000 a month in October 2003, not long after the Iraq war began.

In other words, thousands of American fighters armed with the latest killing technology are taking prescription drugs that the Federal Aviation Administration considers too dangerous for commercial pilots.

Military officials say they believe many medications can be safely used on the battlefield. They say they have policies to ensure that drugs they consider inappropriate for soldiers on the front lines are rarely used. And they say they are not using the drugs in order to send unstable warriors back to war. Yet the experience of soldiers and Marines like Cataldi show the dangers of drugging our warriors. It also worries some physicians and veterans’ advocates.

“There are risks in putting people back to battle with medicines in their bodies,” says psychiatrist Judith Broder, M. D., founder of the Soldiers Project, a group that helps service members suffering from mental illness. Prescription drugs can help patients, Dr. Broder says, but they can also cause drowsiness and impair judgment. Those side effects can be dealt with by patients who are at home, she says, but they can put active-duty soldiers in great danger. She worries that some soldiers are being medicated and then sent back to fight before they’re ready. “The military is under great pressure to have enough people ready for combat,” she says. “I don’t think they’re as cautious as they would be if they weren’t under this kind of pressure.”

… Soldiers have doped up in order to sustain combat since ancient times. Often their chosen sen drug was alcohol. And Iraq isn’t the first place U. S. military doctors have prescribed medications to troops on the front. During the Vietnam war, military psychiatrists spoke enthusiastically about some newly psychiatric medicines, including Thorazine, an antipsychotic, and Valium, for anxiety. According to an army textbook, doctors frequently prescribed those drugs to soldiers with psychiatric symptoms. Anxiety-ridden soldiers with upset bowels were sometimes given the antidiarrheal Compazine, a potent tranquilizer.

But the use of those drugs in Vietnam became controversial. Critics said it was dangerous to give soldiers medications that slowed their reflexes, a side effect that could raise their risk of being injured, captured, or killed. That risk was real. In a report supported by the U. S. Navy 14 years after the United States withdrew from Vietnam, researchers looked at the records of all Marines wounded there between 1965 and 1972. Marines who’d been hospitalized for psychiatric reasons before being sent back to battle were more likely to have been injured in combat than those who hadn’t been hospitalized.

Critics of medication use in Vietnam also said that a soldier traumatized by battle may not be coherent enough to give his consent to take the drugs in the first place. Plus, a soldier would risk court-martial if he refused to follow orders, they said, making it unlikely he could make a reasoned decision about taking the medications.

After the war, the practice of liberally giving psychiatric drugs to warriors fell out of favor. In War Psychiatry, a 1995 military medical textbook, a U. S. Air Force flight surgeon warned about the use of psychiatric drugs, saying they should be used sparingly. “Sending a person back to combat duty still under the influence of psychoactive drugs may be dangerous,” he wrote. “Even in peacetime, people in the many combat-support positions . . . would not be allowed to take such medications and continue to work in their sensitive, demanding jobs.”

Colonel Elspeth Cameron Ritchie, M. D., M. P. H., a psychiatrist and the medical director of the strategic communication directorate in the Office of the Army Surgeon General, acknowledges that writing more prescriptions for frontline troops was a change in direction for the Pentagon. “Twenty years ago,” she says, “we weren’t deploying soldiers on medications. Today it’s not uncommon for a soldier to arrive in Iraq while taking a host of prescription drugs. The Pentagon explained its new practice in late 2006, stating that there are “few medications that are inherently disqualifying for deployment.”

According to Colonel Ritchie, military officials have concluded that many medicines introduced since the Vietnam War can be used safely on the front lines. Military physicians consider antidepressants and sleeping pills to be especially helpful, she says. Doctors have also found that small doses of Seroquel, an antipsychotic, can help treat nightmares, she says, even though the drug is not approved for that use.

Suicidal and homicidal soldiers present one of the most frequent and challenging scenarios for deployed mental health providers. A chart review of 425 deployed soldiers seen for mental health reasons found that 127 (nearly 30%) had considered killing themselves and 67 (nearly 16%) had considered killing someone else (not the enemy) within the past month. Of these, 75 cases were considered severe enough to require immediate intervention. Interventions included unit watch, comprehensive treatment, and medical evacuation. Of the 75 dangerous soldiers, 5 were evacuated out of theater. The rest were returned to duty. Evacuation to a hospital in the rear is often the quickest and most risk-free option but is seldom the best choice for maintaining the fighting force. This article presents several case examples and describes methods for dealing with suicidal and homicidal soldiers during deployment.

(7) Afterword

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